1. Chapter 7
The Nursing Process and Standards of Care in Psychiatric Mental Health Nursing

2. Quality and Safety Education for Nurses (QSEN) Competencies
Patient-centered care
Teamwork and collaboration
Employ Evidence-based practice
Apply Quality Improvement
Safety
Utilize Informatics

3. Standards of Care Standard 1: Assessment Age considerations
Assessment of children
Assessment of adolescents
Assessment of older adults
Language barriers

4. Case Study
A patient who just arrived on your unit says, “I don’t know why you need to do an assessment, I am just here to get my medicines adjusted.”
What is the purpose of a psychiatric mental health nursing assessment?
How would you respond to this patient?

5. Purposes of Psychiatric Assessment
Establish rapport
Obtain understanding of problem
Assess psychological functioning
Identify goals
Perform mental status examination
Identify behaviors/beliefs/areas to be modified to effect positive change
Formulate a plan of care

6. Psychiatric Mental Health Nursing Assessment
Gathering data
Review of systems
Laboratory data
Mental status examination (MSE or MSA)
Psychosocial assessment
Spiritual/religious assessment
Cultural and social assessment
Validating the assessment
Using rating scales - Table 7-1 gives examples

7. Mental Status Examination (MSE/MSA) Box 7-4
Appearance
Behavior & Motor Activity
Attitude
Affect
Mood
Speech

8. MSE (continued) Thought Process How a person thinks Thought Content
flow, rate, logic, coherence
Thought Content
What the person is thinking

9. Cognition (the ability to think)
MSE (continued)
Cognition (the ability to think)
Orientation
Memory
Concentration
Attention Span
Judgment
Insight

10. Psychosocial Assessment
Previous hospitalizations
Education background
Occupational background
Living arrangements
Family issues
Support system
Sexuality
Hobbies/leisure activities
Substance use/abuse

11. Cultural Assessment Cultural background Language
Spiritual/Religious orientation
Attitude toward mental illness in patient’s culture (stigma?)
Health beliefs and practices
What caused this problem?
How is this treated in patient’s culture?
Special dietary needs or considerations
Any cultural beliefs that can help provide patient with better care
Point of identity
Worldview
Time orientation

12. National Behavioral Health Safety Goals
Identifies patient correctly
Uses medicines safely
Prevent infection
Identify patient safety risk
suicide/homicide

13. The Joint Commission Core Measures Inpatient Mental Health
Admission Screening for Violence Risk, Substance Use, Psychological Trauma History and Patient Strengths completed
The total number of hours that all patients admitted to a hospital- based inpatient psychiatric setting were held in seclusion.
Hours of physical restraint use
Patients discharged on multiple antipsychotic medications
Patients discharged from a hospital-based inpatient psychiatric setting with a continuing care plan created
Post discharge continuing care plan transmitted to next level of care provider upon discharge

14. Evidence-Based Practice
Agency for Healthcare Research and Quality
Centre for Evidence-Based Mental Health (CEBMH):
The Cochrane Collaboration:
Box 7-6

15. Standard 2: Diagnosis Three components Problem (unmet need)
Etiology (probable cause)
Supporting data (signs and symptoms)

16. Standard 3: Outcomes Identification
Outcome criteria – Outcomes that reflect the maximal level of patient health that can realistically be achieved through nursing interventions

17. Standard 4: Planning Principles to consider when planning care Safe
Compatible and appropriate
Realistic and individualized
Evidence-based

18. Standard 5: Implementation
Basic interventions
Coordination of care
Health teaching and health promotion
Milieu therapy
Pharmacological, biological, and integrative therapies

19. Standard 5: Implementation (Cont.)
Advanced practice interventions
Prescriptive authority and treatment
Psychotherapy
Consultation

20. Standard 6: Evaluation
Systematic
Ongoing
Criteria-based

21. Question 1
In which part of the nursing care plan would the nurse expect to find this statement:
Offer snacks and finger foods frequently.
Assessment
Diagnosis
Planning and outcomes identification
Intervention
Evaluation

22. Audience Response Questions
A nurse assesses a newly admitted client diagnosed with Alzheimer’s disease and a urinary tract infection. The nurse asks the client’s sibling for information about the home environment, ADLs, and medications. What type of information source is the sibling?
Primary
Secondary
Private
Informed

23. Audience Response Questions
Which term is broader?
Spirituality
Religion
Not sure

24. Audience Response Questions
A nurse taught a client about important precautions associated with a new prescription. Afterward, the client accurately summarized major self-management strategies associated with this drug. Which step of the nursing process applies to the client’s summarization?
Assessment
Analysis
Planning/outcomes identification
Intervention
Evaluation